Volume 8 Issue 11, November 2011

Antithrombotic therapy during percutaneous coronary intervention for ST-segment elevation myocardial infarction has evolved substantially over the past 15 years. With the results of the ATOLL trial, enoxaparin should now be considered a therapeutic alternative to unfractionated heparin in the treatment of such patients. Comparative studies of enoxaparin and bivalirudin, using standardized bleeding definitions, are warranted.

The true prognostic implication of carotid intima–media thickness (CIMT) remains a major question for clinicians and the preventive cardiology community. The merits of using CIMT for assessing asymptomatic individuals at risk for developing cardiovascular disease are discussed, together with the potential issues arising from an analysis of CIMT measurement in the Framingham Offspring Study cohort.

Indisputable evidence that coronary artery calcium score predicts cardiovascular events in asymptomatic individuals exists, even in patients with low to normal LDL cholesterol and elevated C-reactive protein. Conversely, not all studies demonstrate a predictive role for biochemical markers.

Translation of ischemic conditioning into clinical practice has been remarkably slow, but important advances have occurred in the past 5–6 years. This Review provides an update on the use of ischemic conditioning, and describes the results of successful proof-of-concept clinical trials.

Metabolomics is emerging as a powerful tool for the investigation of the molecular mechanisms of cardiovascular disease, including atherosclerosis, ischemia, myocardial infarction, and heart failure. In this Review, the authors discuss advances in the use of NMR spectroscopy and mass spectrometry, particularly in field of lipidomics, and in the search for novel biomarkers of cardiac disease.

Heart failure is a chronic condition that requires a substantial amount of self care by patients. Dr. Riegel and colleagues review heart failure self care in terms of predictors and outcomes, and discuss their implications on clinical practice, public health and policy.

The field of biological cardiac pacing, which aims to improve upon, supplement and, eventually, to replace electronic pacing has come a long way since its inception more than a decade ago. Broadly, research has been focused on gene and cell therapy. In this Review, Rosen and colleagues highlight milestones achieved through the construction of a 'roadmap' in biological pacing, and discuss the barriers that remain to be overcome before clinical trials of biological pacing can be begun.